Associate Business Process Analyst - Columbia, MD or Minnetonka, MN

Company: UnitedHealth Group ( Learn More )

General Information
US-MD-Columbia
N/A
Not Specified
Full-Time
Not Specified
Not Specified
False
False
Job Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

Primary Responsibilities:

  • Understand the overall business model of Medicare Part D products, CMS guidance, and the PBM claim adjudication system and translate concepts into practice
  • Review sample files or claim records to determine appropriate benefit / claim administration is being delivered by the PBM
  • Perform claim / benefit issue identification, communication, root cause analysis, resolution and remediation activities related to claim review
  • Document / support issue tracking, trending, and reporting related to audit and quality review activities
  • Support individual and team goals of affordability, excellence, engagement, compliance and growth
  • Support short term quality and audit activities & research and analyze claim data to support review of audit samples, identify issue and root cause, review and QA audit material, audit universe analysis and QA
  • Support long term activities by influencing or providing input to forecasting and planning discussions; developing audit work plans
  • Work collaboratively with cross - functional and cross - organizational teams & build positive relationships, participate in calls and projects, prioritize tasks and projects to ensure timely completion and effective results
  • Able to work on more complex issues and projects
  • Work with minimal guidance
  • Be a resource for others, explaining complex issues, impacts and outcomes
  • Prioritize and organize own work to meet deadlines

  • Required Qualifications:

  • Undergraduate degree or equivalent experience
  • 1+ years Medicare Part D /  Pharmacy benefit, and / or PBM experience
  • 1+ years experience with performance or oversight of Pharmacy claim analysis and quality practices
  • 1+ years of experience with issue resolution and / or remediation planning
  • Intermediate to advanced level of proficiency with Word, Excel, PowerPoint, and SharePoint
  • Ability to effectively prioritize multiple tasks, priorities, projects, and deadlines
  • Proven success in business analysis and continuous process improvement
  • Demonstrated skills in building and maintaining projects plans and issue logs
  • Strong interpersonal, oral and written communication skills
  • Ability to drive change and influence individuals at all levels of the organization
  • Strong development, analytical, organization, problem - solving, and follow - through skills
  • Ability to work within a less prescribed structure and be generally self - directed
  • Preferred Qualifications:

  • Knowledge of Medicare Part D guidelines and regulations
  • Experience with Pharmacy and / or PBM Operations related to eligibility, benefits and / or claim adjudication
  • Bachelor’s Degree or Certified Pharmacy Technician
  • Intermediate to advanced level of proficiency with MS Project, Access, and Visio
  • Careers at UnitedHealthcare Medicare & Retirement.

    The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)

    Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

     

    UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

    Job Keywords: Associate Business Process Analyst, pharmacy, pharmacy techs, Business analyst, claims, quality, audit, Columbia, MD, Maryland, Minnetonka, MN, Minnesota

    Job Requirements